Risk factor analysis and etiological pathogen spectrum for urinary tract infection in children

Authors

DOI:

https://doi.org/10.14739/2310-1210.2025.3.323423

Keywords:

children, urinary tract infection, uropathogens, risk factors

Abstract

The problem of urinary tract infection (UTI) in children remains relevant in modern pediatrics, pediatric nephrology, and urology, despite the large number of works focused on this issue studies.

Aim. To analyze the potential predictors of development and examine the etiological spectrum of pathogens for urinary tract infection in children.

Materials and methods. Medical documentation of 238 children aged 1 to 14 years was analyzed. Children were divided into two groups: I – children with UTI (n = 140), II – children without UTI (n = 98). The patient group inclusion criteria for children with UTI met the recommendations of the European Society of Pediatric Urology. Urine culture for microbial flora and antibiotic sensitivity were performed according to standard methods.

Results. UTIs occurred in 32.7 % of boys and 26.1 % of girls. The most frequent UTIs were registered in the 1–3 years age group (54.3 %). Sex-specifics of UTIs were noted, varying depending on age: at the age of 1–3 years, girls were 1.3 times more likely to have UTIs than boys (95 % CI: 0.8–2.5); at the age of 4–7 years, boys were 1.4 times more likely to have UTIs (95 % CI: 0.9–3.4) than girls. Most common in children were vesicoureteral reflux (passive 34.5 % and active 19.2 %), cryptorchidism (12.1 %), and pyelectasia (10.3 %). According to the results of questioning, a positive family history of nephro-urological diseases was found in 35.7 % of patients. Age, heredity, neurogenic bladder, duration and number of hospitalizations, anomaly, congenital defect, constipation, intestinal dysbacteriosis, and anemia were identified as factors influencing UTI in children (p < 0.05), while factors such as sex, place of residence, seasonality, and diabetes mellitus had no significant effect. Gram-negative bacterial flora was predominantly identified including Escherichia coli in both observation groups, Klebsiella oxytoca and Acinetobacter baumannii were isolated more often than other microorganisms.

Conclusions. The predominant pathogen in the development of pediatric urinary tract infections is Escherichia coli. Identification of UTI microbiological spectrum will allow for rapid and rational initiation of empirical antibacterial therapy. Independent risk factors for UTI development should be considered when developing strategic guidelines for prevention, early diagnosis, and treatment approaches.

Author Biographies

T. V. Sorokman, Bukovinian State Medical University, Chernivtsi

MD, PhD, DSc, Professor of the Department of Pediatrics and Medical Genetics

M. G. Gingulyak, Bukovinian State Medical University, Chernivtsi

MD, PhD, Associate Professor of the Department of Pediatrics and Medical Genetics

O. V. Makarova, Bukovinian State Medical University, Chernivtsi

MD, PhD, Associate Professor of the Department of Patient Care and Higher Nursing Education

N. O. Popeliuk, Bukovinian State Medical University, Chernivtsi

MD, PhD, Associate Professor of the Department of Pediatrics, Neonatology and Perinatal Medicine

References

  1. Tullus K, Shaikh N. Urinary tract infections in children. Lancet. 2020;395(10237):1659-68. doi: https://doi.org/10.1016/S0140-6736(20)30676-0
  2. Buettcher M, Trueck J, Niederer-Loher A, Heininger U, Agyeman P, Asner S, et al. Swiss consensus recommendations on urinary tract infections in children. Eur J Pediatr. 2021;180(3):663-74. doi: https://doi.org/10.1007/s00431-020-03714-4
  3. Budnik TV. [Microbial inflammatory diseases of the urinary system in children]. Modern Pediatrics. Ukraine. 2019;8(104):57-70. Ukrainian. doi: https://doi.org/10.15574/SP.2019.104.57
  4. Bezruk VV, Bezruk TО, Babiy OR, Sokolnyk SO, Sheremet MI, Maksymyuk VV, et al. Regional monitoring of the etiological spectrum of infectious urinary system pathogens among the children's population of Chernivtsi region: dynamic changes, age, gender and administrative-territorial features. Zaporozhye medical journal. 2017;19(5):647-51. doi: https://doi.org/10.14739/2310-1210.2017.5.110222
  5. NICE Guideline NG224. Urinary Tract Infection in under 16s: Diagnosis and Management. London: National Institute for Health and Clinical Excellence. 2022. Available from: https://www.nice.org.uk/guidance/ng224
  6. Korbel L, Howell M, Spencer JD. The clinical diagnosis and management of urinary tract infections in children and adolescents. Paediatr Int Child Health. 2017;37(4):273-9. doi: https://doi.org/10.1080/20469047.2017.1382046
  7. Marsh MC, Junquera GY, Stonebrook E, Spencer JD, Watson JR. Urinary Tract Infections in Children. Pediatr Rev. 2024;45(5):260-70. doi: https://doi.org/10.1542/pir.2023-006017
  8. González M, Salmón A, García S, Arana E, Mintegi S, Benito J. [Prevalence of urinary tract infection in infants with high fever in the emergency department]. An Pediatr (Engl Ed). 2019;91(6):386-93. Spanish. doi: https://doi.org/10.1016/j.anpedi.2019.01.027
  9. Shaikh N, Osio VA, Wessel CB, Jeong JH. Prevalence of Asymptomatic Bacteriuria in Children: A Meta-Analysis. J Pediatr. 2020;217:110-117.e4. doi: https://doi.org/10.1016/j.jpeds.2019.10.019
  10. Mattoo TK, Spencer JD. Biomarkers for urinary tract infection: present and future perspectives. Pediatr Nephrol. 2024;39(10):2833-44. doi: https://doi.org/10.1007/s00467-024-06321-9
  11. Doğan G, İpek H. Comparison of Primary and Recurrent Urinary Tract Infections in Children. Cureus. 2020;12(2):e7019. doi: https://doi.org/10.7759/cureus.7019
  12. Lu J, Liu X, Wei Y, Yu C, Zhao J, Wang L, et al. Clinical and Microbial Etiology Characteristics in Pediatric Urinary Tract Infection. Front Pediatr. 2022;10:844797. doi: https://doi.org/10.3389/fped.2022.844797
  13. Hsu YL, Chang SN, Lin CC, Lin HC, Lai HC, Kuo CC, et al. Clinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria. Sci Rep. 2021;11(1):11010. doi: https://doi.org/10.1038/s41598-021-90535-6
  14. Yoon SH, Shin H, Lee KH, Kim MK, Kim DS, Ahn JG, et al. Predictive factors for bacteremia in febrile infants with urinary tract infection. Sci Rep. 2020;10(1):4469. doi: https://doi.org/10.1038/s41598-020-61421-4
  15. Buonsenso D, Sodero G, Camporesi A, Pierucci UM, Raffaelli F, Proli F, et al. Predictors of Urinary Abnormalities in Children Hospitalised for Their First Urinary Tract Infection. Children (Basel). 2023;11(1):55. doi: https://doi.org/10.3390/children11010055
  16. Stein R, Dogan HS, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, et al. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol. 2015;67(3):546-58. doi: https://doi.org/10.1016/j.eururo.2014.11.007
  17. Wang J, Zhu H, Huang L, Zhu X, Dong J, Sha J, et al. Risk factors affecting the prognosis of urinary tract infection in Chinese pediatric patients: Single-center experience. Pediatr Int. 2020;62(2):189-92. doi: https://doi.org/10.1111/ped.14007
  18. Ehrlich S, Livni G, Zioni I, Barnea Melamed S, Pasternak Y. Prevalence of Enterococcal Urinary Tract Infections With Positive Nitrites in Urinalysis in Pediatric Patients With High-Risk for Enterococcal Infections. Clin Pediatr (Phila). 2024;63(4):488-93. doi: https://doi.org/10.1177/00099228231179937
  19. Boon HA, Van den Bruel A, Struyf T, Gillemot A, Bullens D, Verbakel JY. Clinical Features for the Diagnosis of Pediatric Urinary Tract Infections: Systematic Review and Meta-Analysis. Ann Fam Med. 2021;19(5):437-46. doi: https://doi.org/10.1370/afm.2684
  20. Millner R, Becknell B. Urinary Tract Infections. Pediatr Clin North Am. 2019;66(1):1-13. doi: https://doi.org/10.1016/j.pcl.2018.08.002
  21. Simões E Silva AC, Oliveira EA, Mak RH. Urinary tract infection in pediatrics: an overview. J Pediatr (Rio J). 2020;96 Suppl 1(Suppl 1):65-79. doi: https://doi.org/10.1016/j.jped.2019.10.006
  22. Alberici I, La Manna A, Pennesi M, Starc M, Scozzola F, Nicolini G, et al. First urinary tract infections in children: the role of the risk factors proposed by the Italian recommendations. Acta Paediatr. 2019;108(3):544-50. doi: https://doi.org/10.1111/apa.14506
  23. Kline JN, Powell LN, Albert JD, Bishara AC, Heffren JC, Badolato GM, et al. Improving Adherence to Evidence-based Practice for Uncomplicated UTI in a Pediatric Emergency Department. Pediatr Qual Saf. 2023;8(3):e654. doi: https://doi.org/10.1097/pq9.0000000000000654
  24. Veauthier B, Miller MV. Urinary Tract Infections in Young Children and Infants: Common Questions and Answers. Am Fam Physician. 2020;102(5):278-85.
  25. Wingler MJ, Tamma PD. Defining effective durations of antibiotic therapy for community-acquired pneumonia and urinary tract infections in hospitalized children. Curr Opin Infect Dis. 2022;35(5):442-51. doi: https://doi.org/10.1097/QCO.0000000000000857
  26. Shaki D, Hodik G, Elamour S, Nassar R, Kristal E, Leibovitz R, et al. Urinary tract infections in children < 2 years of age hospitalized in a tertiary medical center in Southern Israel: epidemiologic, imaging, and microbiologic characteristics of first episode in life. Eur J Clin Microbiol Infect Dis. 2020;39(5):955-63. doi: https://doi.org/10.1007/s10096-019-03810-w
  27. Herthelius M. Antenatally detected urinary tract dilatation: long-term outcome. Pediatr Nephrol. 2023;38(10):3221-7. doi: https://doi.org/10.1007/s00467-023-05907-z
  28. Tezera S, Abebe F, Tachbele E. Urinary tract infections among under-five children with congenital anomalies of kidney and urinary tract in hospitalized patients in Addis Ababa. BMC Pediatr. 2024;24(1):826. doi: https://doi.org/10.1186/s12887-024-05328-3
  29. Rivero Segura M, Ferraris M, Luján Robledo N, Toledo I, Balestracci A. Infección urinaria por Streptococcus pneumoniae y su relación con malformaciones nefrourológicas [Urinary tract infection due to Streptococcus pneumoniae and its relationship with nephrourological malformations]. Andes Pediatr. 2024;95(4):430-5. Spanish. doi: https://doi.org/10.32641/andespediatr.v95i4.4993
  30. Yu X, Tao X, Li S. Analysis of Risk Factors for Urinary Tract Infection in Children and Construction and Validation of a Prediction Model. Arch Esp Urol. 2023;76(6):369-76. doi: https://doi.org/10.56434/j.arch.esp.urol.20237606.44
  31. Ma Q, Li YQ, Meng QT, Yang B, Zhang HT, Shi H, et al. Maternal diseases and congenital anomalies of the kidney and urinary tract in offspring: a cohort study. World J Pediatr. 2024;20(11):1168-78. doi: https://doi.org/10.1007/s12519-024-00822-1
  32. Dinh A, Davido B, Duran C, Bouchand F, Gaillard JL, Even A, et al. Urinary tract infections in patients with neurogenic bladder. Med Mal Infect. 2019;49(7):495-504. doi: https://doi.org/10.1016/j.medmal.2019.02.006
  33. Ross SS, Forster CS, Borawski K. Urinary Tract Infection and Neuropathic Bladder. Urol Clin North Am. 2024;51(4):551-9. doi: https://doi.org/10.1016/j.ucl.2024.06.009
  34. Díaz Álvarez M, Acosta Batista B, Pérez Córdova R, Hernández Robledo E. [Urinary tract infection caused by Enterobacteriaceae and its relationship with vesicoureteral reflux]. Bol Med Hosp Infant Mex. 2017;74(1):34-40. Spanish. doi: https://doi.org/10.1016/j.bmhimx.2016.10.011
  35. Stepanova N. How Advanced Is Our Understanding of the Role of Intestinal Barrier Dysfunction in the Pathogenesis of Recurrent Urinary Tract Infections. Front Pharmacol. 2022;13:780122. doi: https://doi.org/10.3389/fphar.2022.780122
  36. Axelgaard S, Kristensen R, Kamperis K, Hagstrøm S, Jessen AS, Borch L. Functional constipation as a risk factor for pyelonephritis and recurrent urinary tract infection in children. Acta Paediatr. 2023 112(3):543-9. doi: https://doi.org/10.1111/apa.16608
  37. Paalanne N, Husso A, Salo J, Pieviläinen O, Tejesvi MV, Koivusaari P, et al. Intestinal microbiome as a risk factor for urinary tract infections in children. Eur J Clin Microbiol Infect Dis. 2018;37(10):1881-91. doi: https://doi.org/10.1007/s10096-018-3322-7
  38. Wang G, Lin J, Xu J, Jian J, Xu S, Zhong Y, et al. Analysis of relevant influencing factors for recurrent urinary tract infections in children: exploring predictive factors and intervention measures. Am J Transl Res. 2024;16(9):4779-87. doi: https://doi.org/10.62347/AZFV2679
  39. Lee JH, Yim HE, Yoo KH. Associations of Plasma Neutrophil Gelatinase-associated Lipocalin, Anemia, and Renal Scarring in Children with Febrile Urinary Tract Infections. J Korean Med Sci. 2020;35(10):e65. doi: https://doi.org/10.3346/jkms.2020.35.e65
  40. Al Qurabiy HE, Abbas IM, Hammadi AA, Mohsen FK, Salman RI, Dilfy SH. Urinary tract infection in patients with diabetes mellitus and the role of parental genetics in the emergence of the disease. J Med Life. 2022;15(8):955-62. doi: https://doi.org/10.25122/jml-2021-0331
  41. Bodke H, Wagh V, Kakar G. Diabetes Mellitus and Prevalence of Other Comorbid Conditions: A Systematic Review. Cureus. 2023;15(11):e49374. doi: https://doi.org/10.7759/cureus.49374
  42. Demir M, Kazanasmaz H. Uropathogens and antibiotic resistance in the community and hospital-induced urinary tract infected children. J Glob Antimicrob Resist. 2020;20:68-73. doi: https://doi.org/10.1016/j.jgar.2019.07.019
  43. Rosado MR, Molina AG, Velasco AL, Chinchilla GC, Lana PV, Izquierdo EO, et al. Urinary Tract Infection in Pediatrics: Study of Uropathogens and Their Resistance in a Madrid Hospital. Arch Esp Urol. 2022;75(9):791-7. doi: https://doi.org/10.56434/j.arch.esp.urol.20227509.115
  44. Agrawal P, Paunikar VM. Urinary Tract Infection in Children: A Narrative Review. Cureus. 2024;16(1):e51469. doi: https://doi.org/10.7759/cureus.51469

Downloads

Additional Files

Published

2025-06-17

How to Cite

1.
Sorokman TV, Gingulyak MG, Makarova OV, Popeliuk NO. Risk factor analysis and etiological pathogen spectrum for urinary tract infection in children. Zaporozhye Medical Journal [Internet]. 2025Jun.17 [cited 2026May16];27(3):214-20. Available from: https://zmj.zsmu.edu.ua/article/view/323423

Issue

Vol. 27 No. 3 (2025)

Section

Original research

License

Copyright (c) 2025 T. V. Sorokman, M. G. Gingulyak, O. V. Makarova, N. O. Popeliuk

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons